Pharmacotherapeutic perspectives on nutraceuticals in the treatment of MASLD and MASH

Abstract

Metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunctionassociated steatohepatitis (MASH) continue to be serious global health concerns despite various concerted efforts. There has been significant progress in pharmacological treatments for these conditions. The recent FDA approval of resmetirom marks a milestone as the first medication specifically approved for MASH treatment.1 Nonetheless, there is an unmet need for more efficacious or adjunctive approaches. Thus, exploration of various therapeutic approaches is ever increasingly needed. One avenue that has garnered attention in the fight against MASLD and MASH is the utilization of nutraceuticals. These are food-derived products that exhibit a plethora of health benefits beyond basic nutrition. They exert several beneficial effects in the battle against cardiovascular disease, cancer, inflammation, and metabolic disease, among others, especially since most of them are plant-derived or nature-inspired.2–5 However, the current evidentiary basis for their efficacy remains limited and inconsistent. This necessitates a critical appraisal of the available literature before recommendations can be made. Recently, a consensus on the importance of diet and nutrition as integral elements of MASLD management has been published.6 This report highlights the importance of a balanced healthy diet and body weight control, as well as the integration of personalized nutritional interventions (e.g. caloric restriction and intermittent fasting).6 In addition, eating whole rather than refined grains and reducing fat/meat intake are strongly recommended. Interestingly, and in line with the premise of our perspective regarding nutraceuticals, eating healthy sources of protein, notably from plant sources, was one of the key recommendations.6 Some of the molecules that received the most attention are omega-3 fatty acids, vitamin E, curcumin, in addition to probiotics and synbiotics.